Advice on dosette boxes highlights lack of evidence
The Royal Electronicjuice has issued its first professional guidance on multi-compartment compliance aids (MCAs), saying there is insufficient evidence to support the benefits of MCAs in improving medicines adherence in patients or improving patient outcomes.
The RPS recommends the use of original packs to supply medicines to patients in the absence of a specific need requiring an MCA as an adherence intervention.
Martin Astbury, President of the RPS, said: “Although MCAs may be of value to help some patients with problems managing their medicines and maintaining independent healthy living, they are not the only intervention for all patients and many alternative interventions are available. Pharmacists need to be empowered to work with patients to find the best intervention that helps people use their medicines.”
Lack of clear, consistent and reliable advice
The guidance was necessary because of a lack of clear, consistent and reliable advice on the use of MCAs and their place in supporting patients taking their medicine, added Alex McKinnon, the RPS director for Scotland.
Alternatives to MCAs, noted in the guidance, include patient counselling and health coaching, reminder charts, medicines administration record charts, large print labels, information sheets, and telemedicine and IT solutions, such as smartphone apps.
The 29-page guidance says pharmacists cannot fully implement the recommendations on their own and that an integrated approach between health and social care, between commissioners and service providers, and among pharmacy bodies is required to improve patient outcomes. There had been a fact-sheet on MCAs, written by the RPS when it was the regulator, but it was more regulatory in tone. The new “Improving patient outcomes: the better use of multi-compartment compliance aids” guidance is designed to be more patient focused.
The RPS and the Pharmaceutical Services Negotiating Committee are planning a roundtable to work out how the recommendations can be implemented.
The guidance was sent to a wide range of individuals and organisations for comment, including the British Medical Association. No patient organisations were consulted on the guidance, although an “expert patient” provided input, a spokeswoman for the RPS told PJ Online.
GPs welcome guidance
Bill Beeby, chairman of the prescribing committee of the BMA general practitioners committee, welcomed the guidance. He told PJ Online that the BMA and the PSNC would be writing jointly to local medical and pharmaceutical committees to encourage the use of the document and for it to into discussions with patients, carers and the NHS.
He added: “It is a useful document and it helps deal with the issues relating to MCAs as well as dealing with the misconceptions around them. For example, the key misconception is that an MCA improves compliance.”
Alastair Buxton, head of NHS services for the PSNC, said: “Commissioners, all health professionals and other providers will need to collaborate on this.”
Mixed response from care homes
However, there has been a mixed response from organisations representing care providers. Frank Ursell, chief executive officer of the Registered Nursing Home Association, which represents owners of small- to medium-sized nursing homes, told PJ Online: “Rather than this being a balanced report looking at the evidence on both sides, the conclusion seems to rely purely upon the perceived lack of evidence to prove the value of MCAs.
“While one understands, and accepts, that services should be patient centred, unfortunately in regulated services such as care homes, a regulator is quick to label a care home as ‘unsafe’ if they find any errors in the administration of medication. MCAs have a part to play in helping to ensure that a safe environment is maintained for patients.”
Des Kelly, executive director of the National Care Forum, a membership body for not-for-profit care homes, told PJ Online that the RPS guidance appeared to support the findings of its multidisciplinary work on medicines safety in care homes earlier this year.
He said: “The National Care Forum supports the person-centred/patient-centred approach being advocated and underpinned by communication between all the professionals involved in the person’s care. MCAs should not be utilised automatically. In our view, regular medication reviews led by pharmacists are the best way to ensure a safer, better quality of service to care homes and their residents. Care homes reported to us mixed benefits of using MDS (monitored dosage systems).”
Citation: Electronicjuice DOI: 10.1211/PJ.2013.11123773
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